The Role of Difficulty in Identifying and Describing Feelings in Non-Suicidal Self-Injury Behavior (NSSI): Associations With Perceived Attachment Quality, Stressful Life Events, and Suicidal Ideation

Abstract

Objective: Core alexithymic features, such as the difficulty in identifying and describing feelings, are associated with poor attachment styles and emotional trauma, which influence the capacity to regulate affect. Additionally, emotional regulation has been found to be the most commonly identified function associated with non-suicidal self-injury behavior (NSSI) in adolescents as they attempt to modulate strong emotions. However, few studies have examined the link between difficulty in identifying and describing feelings (core components of alexithymia), NSSI behaviors, quality of attachment, life stressors and suicidal ideation in healthy early adolescents. Consequently, this study aims to investigate these constructs and the relationship among them in a large non-clinical sample of adolescents.Methods: Seven hundred and nine middle school students (50.4% males), aged 10–15 years (M = 12.6; SD = 1.06) were involved in this study. In order to investigate the variables considered in the study, the following measures were administered: the Deliberate Self-Harm Inventory exploring non-suicidal self-injurious behaviors; the Alexithymia Questionnaire for Children examining difficulty in identifying and describing feelings; the Inventory of Parent and Peer Attachment assessing the quality of parental and peer attachment; the Life Stressor Checklist-Revised outlining stressful/traumatic events and the Children’s Depression Inventory evaluating suicidal ideation.Results: We found significantly positive relationships among difficulty in identifying and describing feelings, NSSI behaviors, stressful events, and suicidal ideation. Data indicated a significant negative association of difficulty in identifying and describing feelings with quality of attachment to parents and peers. Further findings highlighted that difficulty in identifying and describing feelings significantly mediated the effect of quality of attachment (parent and peer) on NSSI and suicidal ideation.Conclusion: The ability to identify and describing feelings is important to managing emotional expression and understanding the feelings of others, both crucial in attaining successful interpersonal relationships. Our data revealed that, while controlling for stressful life events, low levels of attachment may increase adolescents’ difficulty in identifying and describing their own feelings, which in turn may increase the risk of both NSSI and suicidal ideation.

Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents

“…These findings also confirm a previous report from Gatta et al (19) on a non-clinical population of adolescents: those engaging in self-harming had considerably more difficulty in recognizing and expressing their own and others' emotional states, suggesting a fundamental role for alexithymia in the onset of NSSI (19). Similar evidence comes from other research in Italy and New Zealand (23,24), suggesting that alexithymia is a risk factor for NSSI as a dysfunctional coping mode, as well as by neuroimaging studies using functional magnetic resonance imaging (25).…”

“…An Italian study on a non-clinical adolescent population found a positive association between difficulty in identifying and describing one's feelings and NSSI behavior. It also found that dysfunctional relationships with peers and parents can raise the risk of NSSI and suicidal ideation, consequently impairing an adolescent's ability to identify their emotions (23).…”

Links between self-injury and suicidality in autism

“…That both alexithymia and sensory disturbances are predictive of self-injury in autistic people is consistent with the prevalence of these features in other self-harming populations, and with the relationship that both alexithymia and sensory differences show with internalizing symptoms and/or mental ill-health in autism [41][42][43][44][45][46]. Alexithymia is higher than average in adolescent selfharmers and is a well-known correlate of self-injury in clinical populations [47][48][49]. Sensory disturbances have been a topic of interest as pertains to self-injury in autistic children and teenagers with and without intellectual disability.…”

Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults’ Non-Suicidal Self-injury

“…Although numerous studies have used similar frequency bands (e.g., Buser et al, 2019;Hasking, Boyes, Finlay-Jones, McEvoy, & Rees, 2019;Midkiff et al, 2018;Whitlock et al, 2013), this approach may result in reduced power or conflate potentially different degrees of NSSI. That said, extant measures that employ count report formats may inadvertently bias reports to favor particular frequency ranges by suggesting count metrics (e.g., 1, 5, 15 in Cerutti, Zuffianò, & Spensieri, 2018;0, 10, 100, 500 in Nielsen, Sayal, & Townsend, 2017). Similarly, studies of NSSI vary with regard to duration, with some studies assessing NSSI events during the prior year as in the current study (e.g., Hasking et al, 2019;Muehlenkamp, Xhunga, & Brausch, 2019), in the past month (e.g., Auerbach et al, 2014;Fox et al, 2019), or over the course of the respondent's life time (e.g., Cerutti et al, 2018).…”

“…That said, extant measures that employ count report formats may inadvertently bias reports to favor particular frequency ranges by suggesting count metrics (e.g., 1, 5, 15 in Cerutti, Zuffianò, & Spensieri, 2018;0, 10, 100, 500 in Nielsen, Sayal, & Townsend, 2017). Similarly, studies of NSSI vary with regard to duration, with some studies assessing NSSI events during the prior year as in the current study (e.g., Hasking et al, 2019;Muehlenkamp, Xhunga, & Brausch, 2019), in the past month (e.g., Auerbach et al, 2014;Fox et al, 2019), or over the course of the respondent's life time (e.g., Cerutti et al, 2018). It is not yet clear if and how these variations may influence NSSI distributions and, by extension, the relative effectiveness of statistical approaches for addressing data skewness.…”